| National Provider Identifier [NPI]: | 1750382099 |
| Last Name Of The Provider | BUSTOS |
| First Name Of The Provider | LUIS |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 29135 RYAN RD |
| Street Address 2 Of The Provider | SUITE B |
| City Of The Provider | WARREN |
| Zip Code Of The Provider | 480924276 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 67 |
| Number Of Services | 1735 |
| Number Of Medicare Beneficiaries | 653 |
| Total Submitted Charge Amount | 472554 |
| Total Medicare Allowed Amount | 177937.12 |
| Total Medicare Payment Amount | 137910.54 |
| Total Medicare Standardized Payment Amount | 129918.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 51 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 1594 |
| Total Drug Medicare AllowedAmount | 408.65 |
| Total Drug Medicare PaymentAmount | 337.47 |
| Total Drug Medicare Standardized Payment Amount | 337.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 1684 |
| Number Of Medicare Beneficiaries With Medical Services | 653 |
| Total Medical Submitted Charge Amount | 470960 |
| Total Medical Medicare Allowed Amount | 177528.47 |
| Total Medical Medicare Payment Amount | 137573.07 |
| Total Medical Medicare Standardized Payment Amount | 129581.31 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 186 |
| Number Of Beneficiaries Age 65 to 74 | 207 |
| Number Of Beneficiaries Age 75 to 84 | 173 |
| Number Of Beneficiaries Age Greater 84 | 87 |
| Number Of Female Beneficiaries | 392 |
| Number Of Male Beneficiaries | 261 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 607 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 305 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 348 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 37 |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 67 |
| Percent Of With Chronic Kidney Disease | 67 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 43 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 70 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 64 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 35 |
| Average HCC Risk Score Of Beneficiaries | 3.7846 |